Provider Demographics
NPI:1801000120
Name:COUNSELING AND NEUROTHERAPY ASSOCIATES LLC
Entity Type:Organization
Organization Name:COUNSELING AND NEUROTHERAPY ASSOCIATES LLC
Other - Org Name:DARBY CREEK COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MAUST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-845-8652
Mailing Address - Street 1:1375 US HIGHWAY 42 SE
Mailing Address - Street 2:SUITE C
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-9548
Mailing Address - Country:US
Mailing Address - Phone:740-845-8652
Mailing Address - Fax:614-503-0899
Practice Address - Street 1:1375 US HIGHWAY 42 SE STE C
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-9548
Practice Address - Country:US
Practice Address - Phone:740-845-8652
Practice Address - Fax:614-503-0899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 101YM0800X, 101YP2500X, 104100000X, 1041C0700X, 106H00000X
OHE1444101YM0800X
OHE-0002792101YM0800X
OHC1400288101YP2500X
OHS.0022849104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0038893Medicaid